Idiopathic granulomatous mastitis

Abstract

: Idiopathic granulomatous mastitis (IGM) is a rare, benign breast condition characterized by multiple draining sterile breast abscesses. This condition of unknown etiology commonly presents in young, parous women with a recent history of lactation and of Mediterranean or Hispanic descent. IGM commonly presents unilaterally with localization in the upper outer quadrant but can present in any quadrant or both breasts concurrently. This disease can mimic breast cancer on various imaging modalities causing concern as well as presenting with erythema, breast edema, breast pain, and sinus tract formation. IGM is diagnosed through the exclusion of all other common pathogens and diseases as well as distinct histological findings of non-caseating granulomas and multinucleated giant cells upon core needle biopsy. IGM is a self-limiting disease and can self-resolve on an average of 5 months, but treatment modalities are recommended to help manage the symptoms. Treatment methods range from observation, steroids, methotrexate and surgical excision with relapse commonly occurring. Currently, no consensus within the literature exists on the best treatment strategy. Each treatment method has various advantages and disadvantages, therefore this review aims to provide focused, up-to-date guidance on of IGM. This review specifically highlights each treatment method, showcases studies on different treatment modalities in a comprehensive table, and provides a precise algorithm for clinicians on the workup and treatment of IGM.